The Effect of SARS-CoV-2 Outbreak on Diabetic Ketoacidosis Presentation in Children with New Onset Type 1 Diabetes Mellitus.

INTRODUCTION: Diabetic ketoacidosis (DKA) is a life-threatening acute complication of type 1 diabetes mellitus (T1DM) and infection is the most common precipitating factor and is responsible for more than 50% of cases. The frequency and severity of diabetic ketoacidosis in children with T1DM, before and during the coronavirus disease 2019 outbreak were evaluated in order to identify its effects on DKA incidence.

METHODS: COVID-19 pandemic group comprised new onset T1DM patients presenting from March 2020 to March 2021. Control group included new onset T1DM from March 2016 to March 2020.

RESULTS: The rate of DKA at presentation was similar during the pandemic period compared to the pre-pandemic years (58,3% in 2020 vs 55.3% in 2019, 45.5% in 2018, 44.8% in 2017, 64.3% in 2016, p =0. 393). Although the percentage of DKA was similar, the rate of severe DKA in the last 2 years was higher than previous years. Although statistically insignificant, the duration of diabetes symptoms was longer in the COVID-19 period than the previous years.

CONCLUSION: This study suggests that the rate of severe DKA, but not the overall rate of DKA, has increased during COVID-19 pandemic and lock-down compared to the prior 4 years. This may be mainly due to the behavior of the parents of sick children and effectiveness of healthcare system. Despite many road-blocks due to overburden of healthcare system during COVID-19 pandemic, parents might have been concerned enough to seek medical attention for their children, avoiding increased frequency of DKA as the first presentation of new-onset T1DM.